CPT 12001: Simple repair of superficial wound, ≤2.5 cm

Medicare pays $118 and commercial payers pay $192 on average nationally for this procedure.

CPT code 12001 describes the simple repair of superficial lacerations of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) measuring 2.5 cm or less; service type: simple wound repair; typical site of service: emergency department, urgent care, or outpatient clinic.

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National Reimbursement Benchmarks

Medicare's mean reimbursement for CPT 12001 sits at $117.7, which is modestly lower than BUCA's average commercial mean of $192.5. This gap of $74.8 highlights a significant commercial premium versus the federal program, with Medicare concentrated in a narrow middle band (P25 $110 to P75 $123) reflecting relatively stable, locality-driven payments.

Examining dispersion across payers using the interquartile range (P75 minus P25) shows variation in distribution tightness: Blue Cross Blue Shield has a wide IQR of $104 (P75 $306.1 minus P25 $202.1), indicating substantial variability in commercial contracts, while Aetna's IQR is $86 (P75 $129.9 minus P25 $41.3). UnitedHealth Group's IQR is $83 (P75 $170.5 minus P25 $82.7), Cigna's IQR is $97 (P75 $163.9 minus P25 $68.0), and BUCA's IQR is $93 (P75 $241.2 minus P25 $142.9), placing Blue Cross Blue Shield as the most dispersed and UnitedHealth Group as the tightest among these payers.

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CPT 12001: Simple repair of superficial wound, ≤2.5 cm

Medicare pays $118 and commercial payers pay $192 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 12001 policy alerts

Get alerted when payer policies referencing 12001 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 28-year-old male presents to the emergency department after striking his head on a low beam while moving a ladder. He has a 2.0 cm superficial laceration to the scalp without evidence of a retained foreign body. After triage and wound assessment, local anesthesia is administered, the wound is irrigated, hemostasis is achieved, and a simple layered closure with interrupted sutures is performed. The procedure is documented as a simple repair of a superficial wound of the scalp measuring 2.0 cm, consistent with CPT 12001. The patient is discharged with wound care instructions and scheduled for suture removal in 7 days.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`12002`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm	Use when the simple wound length falls between 2.6 cm and 7.5 cm instead of `12001`

| 12006 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm | Use when the simple wound length is between 7.6 cm and 12.5 cm and exceeds the size limit for 12001

Related Modifiers

6 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
261QR0200X	Radiology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune…
2279P3800X	Palliative/Hospice Registered Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
204D00000X	Neuromusculoskeletal Medicine & OMM Physician	The Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician directs special attention to the neuromusculoskeletal system and its…
261QS0132X	Ophthalmologic Surgery Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

CPT 12002: Simple Repair of Superficial Wounds 2.6–7.5 cm

CPT-12004-SIMPLE-REPAIR-SUPERFICIAL-WOUND-7-6-12-5-CM

CPT 12004: Simple Repair of Superficial Wounds 7.6–12.5 cm

CPT-12005-SIMPLE-REPAIR-SUPERFICIAL-WOUND-12-6-TO-20CM

CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

CPT-12006-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-20-1-30-CM

CPT 12006: Simple Repair of Superficial Wound 20.1–30.0 cm

CPT-12007-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-OVER-30CM

CPT 12007: Simple repair of superficial wound >30.0 cm

CPT-12011-SIMPLE-REPAIR-SUPERFICIAL-FACIAL-WOUND-2-5CM-OR-LESS

CPT 12011: Simple Repair of Superficial Facial/Mucous Membrane Wounds ≤2.5 cm

CPT-12013-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-2-6-5-0-CM

CPT 12013: Simple Repair of Superficial Facial Wounds, 2.6–5.0 cm

CPT-12014-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-5-1-7-5-CM

CPT 12014: Simple Repair of Superficial Facial Wounds 5.1–7.5 cm

CPT-12015-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-76-125-CM

CPT 12015: Simple Repair of Superficial Facial Wounds 7.6–12.5 cm

CPT-12016-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-12-6-20-CM

CPT 12016: Simple Repair of Superficial Wounds, Face 12.6–20 cm

Showing 1–10 of 14

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`12002`	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm	Use when the simple wound length falls between 2.6 cm and 7.5 cm instead of `12001`

Related Modifiers

6 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
261QR0200X	Radiology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune…
2279P3800X	Palliative/Hospice Registered Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
204D00000X	Neuromusculoskeletal Medicine & OMM Physician	The Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician directs special attention to the neuromusculoskeletal system and its…
261QS0132X	Ophthalmologic Surgery Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

CPT 12002: Simple Repair of Superficial Wounds 2.6–7.5 cm

CPT-12004-SIMPLE-REPAIR-SUPERFICIAL-WOUND-7-6-12-5-CM

CPT 12004: Simple Repair of Superficial Wounds 7.6–12.5 cm

CPT-12005-SIMPLE-REPAIR-SUPERFICIAL-WOUND-12-6-TO-20CM

CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

CPT-12006-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-20-1-30-CM

CPT 12006: Simple Repair of Superficial Wound 20.1–30.0 cm

CPT-12007-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-OVER-30CM

CPT 12007: Simple repair of superficial wound >30.0 cm

CPT-12011-SIMPLE-REPAIR-SUPERFICIAL-FACIAL-WOUND-2-5CM-OR-LESS

CPT 12011: Simple Repair of Superficial Facial/Mucous Membrane Wounds ≤2.5 cm

CPT-12013-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-2-6-5-0-CM

CPT 12013: Simple Repair of Superficial Facial Wounds, 2.6–5.0 cm

CPT-12014-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-5-1-7-5-CM

CPT 12014: Simple Repair of Superficial Facial Wounds 5.1–7.5 cm

CPT-12015-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-76-125-CM

CPT 12015: Simple Repair of Superficial Facial Wounds 7.6–12.5 cm

CPT-12016-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-12-6-20-CM

CPT 12016: Simple Repair of Superficial Wounds, Face 12.6–20 cm

Showing 1–10 of 14

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 12001: Simple repair of superficial wound, ≤2.5 cm

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National Reimbursement Benchmarks

OpenPayer

CPT 12001: Simple repair of superficial wound, ≤2.5 cm

Sign up for cpt 12001 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 12001: Simple repair of superficial wound, ≤2.5 cm

Sign up for cpt 12001 policy alerts

National Reimbursement Benchmarks

CPT 12001: Simple repair of superficial wound, ≤2.5 cm

Sign up for cpt 12001 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations is CPT 12001 used for?

Which CPT codes are closely related and when should they be used instead?

What ICD-10 diagnosis codes commonly align with billing CPT 12001?

In which sites of service is CPT 12001 typically performed?

Which payers are noted as covering this code in the summary metadata?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations is CPT 12001 used for?

Which CPT codes are closely related and when should they be used instead?

What ICD-10 diagnosis codes commonly align with billing CPT 12001?

In which sites of service is CPT 12001 typically performed?

Which payers are noted as covering this code in the summary metadata?

References